Provider Demographics
NPI:1306038666
Name:PREST, THOMAS MARK (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARK
Last Name:PREST
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MEMORIAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2662
Mailing Address - Country:US
Mailing Address - Phone:434-845-5944
Mailing Address - Fax:434-845-0840
Practice Address - Street 1:2600 MEMORIAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2662
Practice Address - Country:US
Practice Address - Phone:434-845-5944
Practice Address - Fax:434-845-0840
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical